Rules Under Development

Medical Aid Rules

Chapter 296-20, WAC

The purpose of this rulemaking is to repeal the Structured Intensive Multidisciplinary Program (SIMP) rules, WACs 296-20-12055 through 296-20-12095, thereby bringing the DepartmentÃ­s rules into compliance with a recent coverage determination by the Washington State Health Technology Clinical Committee (HTCC). The HTCC made a determination that lumbar fusion for uncomplicated degenerative disc disease (UDDD) is no longer a covered procedure. Before this non-coverage determination was made, a previous HTCC determination required lumbar fusion candidates with UDDD to attend a SIMP prior to having surgery. This previous coverage determination is contained within the SIMP rules and is now inconsistent with this new HTCC non coverage determination. The DepartmentÃ­s payment policies, the lumbar fusion surgical guideline and a medical coverage decision have already been amended effective March 7, 2016 in response to the HTCC lumbar fusion for UDDD non-coverage determination.
SIMP program requirements are currently also contained within the DepartmentÃ­s fee schedulesÃ­ payment policies and, other than removing the lumbar fusion for UDDD requirement, will remain in effect when the SIMP rules are repealed. The changes were adopted 11/1/2016 and became effective on 12/2/2016.762.

Medical Aid Rules (WAC Chapters 296-20-135, 296-23-220, 296-23-230)

The purpose of this rulemaking is to update conversion factors provided in WAC 296-20-135 and maximum daily fees provided in WAC 296-23-220 and WAC 296-23-230 for certain professional health care services for injured workers. Rule changes are necessary to maintain current overall fees for health care services, which are published annually in the Medical Aid Rules and Fee Schedules. The changes were adopted 5/3/2016 and became effective on 7/1/2016.744.

The rules changes are needed to ensure the agency is current in its use of the federally adopted diagnosis code set. Although L&I is not required to make these changes, the agency is doing so to decrease administrative burden on the provider community if and when the federal government adopts a new code set. If L&I does not make the change, providers would need to maintain dual billing systems to accommodate the outdated L&I billing model while they adhere to the federally adopted, industry standard code set used by other payers. The changes were adopted 8/18/2015 and became effective on 10/1/2015.728.

Travel Expense Reimbursement (WAC 296-20-1103)

In response to a petition for rulemaking, Labor and Industries is adopting changes to amend the travel expense rule, WAC 296-20-1103, to better align with RCW 51.32.099(3)(e) regarding the reimbursement of the cost of transportation for a worker who is actively participating in a retraining plan. The changes were adopted 6/30/2015 and became effective on 8/1/2015.725.

The affected rules describe elements used in the process of updating the maximum allowable payments for most professional health care services. These elements are set in rule in order to follow the established methodologies of L&I and maintain consistency with the Health Care Authority and Medicaid Purchasing Administration. The changes were adopted 4/21/2015 and became effective on 7/1/2015.722.